Cupcake Bans and Cheeseburger Lunches

Fighting Child Obesity in Schools

ATHENS – In the cafeteria of the Athens Middle School, the chatter of students fills the air. It is lunchtime.

The students eat their meals at long wooden tables, surrounded by high white walls, decorated with posters. One of the posters displays a muscular athlete holding a baseball bat. “Got milk?”, the poster says. “Milk’s got nutrients you need to refuel. Eat right, exercise and drink low fat milk.”

Another poster depicts a pyramid divided into different colors. The colors stand for grains, vegetables, fruits, milk and meat and beans. “My Pyramid”, it says.

“Eat right. Exercise. Have fun.”

Today’s menu is a beef and bean burrito with Mexican rice. Apart from the menu, the school cafeteria offers pizza, burritos, hamburgers, cheeseburgers, chicken burgers, fries, tots and grilled chicken sandwiches.

There is also a small salad bar. It offers lettuce, sliced cucumber, finely chopped tomatoes and onions, cheese, bacon bits, eggs, chicken, banana peppers and four kinds of salad dressings.

A 7^th grade boy walks along the warm food counter and opens the glass door of a case filled with paper-wrapped hamburgers. He grabs a burger, lays it on his tray and walks on, leaving the salad bar vacant.

A girl approaches the fruit section: one bowl with fresh fruit – containing about 5 oranges and 5 browning bananas – and another bowl with canned fruit. The girl’s hand hovers above the oranges and bananas for a second, but then grabs a plastic bowl and fills it with the canned fruit. On her tray are a hamburger and a box of fries.

“Many parents are concerned about the food offered in school cafeterias”, said Karen Bailey, a dietitian in Athens County. About one tenth of her patients are kids struggling with obesity. Because many children eat their lunch at school, school meals are an important part of a child’s daily diet.

Child obesity is a serious issue in both Ohio and Athens County. Numbers from the Ohio Family Health Survey show that “more than 1 out of every 3 children (10-17 years) in Ohio is overweight or obese (17.1% of all children are overweight and 18.5% of all children are obese).” This means that there are approximately 500.000 overweight or obese children in Ohio.

A study by researchers at the Ohio University College of Osteopathic Medicine (OU-COM) showed that 21% of children in Athens County are obese, compared to a national average of 16%. The study also shows that overweight children are more likely to eat meals at school and watch television.

Obesity can lead to grave health problems. Many of Bailey’s young patients are diabetic or prediabetic, a state in which the patient has some but not all of the symptoms of diabetes. Apart from diabetes, obesity increases the risks of high blood pressure, heart disease, arthritis (joint disease), liver disease and cancer.

Apart from physical diseases, obesity can also lead to mental diseases such as depression and concentration problems.

Diane Whitmore Schanzenbach, PhD in education policy, child health and food consumption, wrote in a research paper that children spend a substantial part of their waking hours in school, and consume one-third to one-half of their daily calories there.

“This is why school polities can be a promising place to implement public health strategies aimed at reducing obesity,” Whitmore Schanzenbach said.

Tammy Dicken, director of food services, decides what meals are served at the schools of the Athens City School district. She leads a staff of 25 cafeteria ladies who work at the schools in the district.

When deciding what foods to purchase, Dicken finds it important to include healthy options. “We want to make sure that there are fresh fruits and vegetables. We also have low fat milk, apple juice and orange juice.”

The school cafeterias do not offer soft drinks like Coca Cola or Mountain Dew. But they do offer snacks like chips, cookies and chewy bars.

Bailey said that soft drink companies often pay schools to place soda machines in their cafeteria. “I bet it is the same for snack companies,” Bailey said. “Why would school cafeterias offer foods like chips? Certainly not because they think the kids need it.”

Many fast foods and processed foods, however, are cheaper than the fresh and nutritional ones. Purchasing these foods can therefore be more attractive to schools and families with a lower budget.

Considering the importance of the nutritional value of school meals, Dicken has to make sure that the meals meet certain national guidelines. These guidelines recommend that no more than 30% of an individual’s calories come from fat, and less than 10 percent from saturated fat.

According to the USDA, schools lunches also have to provide one‐third of the Recommended Dietary Allowances of protein, Vitamin A, Vitamin C, iron, calcium, and calories.

As long as the school lunches meet these requirements, local school food authorities like Dicken’s can decide what specific foods to serve and how they are prepared.

But what the children finally will eat is up to them and their parents. “The students are free to make their own choices,” Dicken said. The canteens offer healthy options, but they also offer chicken nuggets and hamburgers (even though Dicken makes sure that none of the foods are fried; the chicken nuggets and hamburgers are baked).

“In the end,” Dicken said, “the children decide what they will eat.”

“USDA’s guidelines are fairly good requirements,” Bailey said. “But the problem is that the children don’t always choose the foods that meet these requirements, even though they are available in the school canteen.” In reality, many of the trays in the Athens Middle School cafeteria are filled with tortilla chips and melted cheese, hamburgers and ketchup.

Bailey has an 11-year old daughter who goes to school in Athens. “She does not like the food in the cafeteria,” Bailey said. “She usually brings her own lunch from home.” Bailey encourages her daughter to take at least one piece of fruit and yoghurt with her.

But not all parents are in the financial position to let their children bring a homemade lunch to school. “That is why it is important for school cafeterias to offer healthy meals,” Bailey said.

But if children still choose the unhealthy options, then wouldn’t it be better for schools to prohibit the offer of unhealthy foods in school cafeterias?

“Across the country, school districts have banned certain foods to fight obesity,” said Linda Scovern, nutrition and physical activity coordinator at the Ohio Department of Health (ODOH). “Some schools have even prohibited the offer of cupcakes during birthday celebrations,” Scovern said.

But Scovern doesn’t think it’s a good idea for local districts to turn into the ‘food police.’ “Where are they supposed to draw the line?” she said. “What are ‘bad’ foods? Eating cupcakes doesn’t have to be a bad thing, as long as you don’t do it every day.”

Scovern and Bailey both agree that it would be a good idea to make healthy eating more attractive to children.

“The presentation of the food can make a lot of difference,” Bailey said. If a cafeteria has a meager offering of fresh fruits and vegetables, this can make the less healthy options all the more attractive.

“Maintaining a healthy lifestyle is much easier if you turn it into something fun,” Bailey said. She often motivates her young patients by giving them reward stickers or making goal calendars with food goals and exercise goals.

“Kids usually come in to my practice with their parents, because parents play a big role when it comes to their child’s diet,” Bailey said. “But it is important that the parents don’t do all the talking while their child silently sits in his or her chair.”

Bailey also pointed out the importance of exercise. “Kids need about one hour of exercise a day,” she said. “And in order to loose weight, children have to exercise 60 to 90 minutes a day.” The schools in Athens largely contribute to this principle with their daily PE classes that take about 45 minutes.

Also governmental programs promote a healthy lifestyle, like the Safe Routes to School (SRTS) program, organized by the Ohio Department of Transportation (ODOT). The SRTS program has the goal to encourage children to walk or cycle to school. Last year, ODOT awarded about $11 million to communities across Ohio for crossing signals, bike and pedestrian facilities, school travel plans and educational materials.

“More than a third of youths aged 9 to 15 live within a mile of school,” ODOT writes on its website. “But less than half of these students walk or bike even one day a week. This is a lost opportunity for students to get much-needed physical activity and to learn more about their neighbors and the community.”

In 2009, the ODOH launched the Ohio Obesity Prevention Plan containing the chapter Improving Schools and Child Care Environments. In this chapter, the ODOH mentioned goals focused on stimulating a healthy lifestyle by making healthy options more accessible, rather than prohibiting unhealthy options.

As an example, the ODOH wants to increase the number of schools in Ohio using the national Farm to School program with 50 schools by the end of 2015.

This program, as said on its website, “connects schools and local farms with the projectives of serving healthy meals in school cafeterias, improving student nutrition, providing agriculture, health and nutrition education opportunities, and supporting local and regional farmers.”

Farm to School also offers education opportunities like planting school gardens, cooking demonstrations and farm tours. “The Farm to School approach helps children to understand where their food comes from and how their food choices impact their bodies, the environment and their communities at large,” informs the program’s website.

Bailey is a big supporter of initiatives like Farm to School. “Such programs involve the kids in the process of food production, which makes them more aware of what they are eating.”

Although more than one third of Ohioan children are obese or overweight, there are plans on the table that can make a change. Plans that involve more than hanging posters about nutrition in school canteens on an adult’s eye level.

Hopefully, they will contribute to the health of Ohio’s children.

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